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Charges for Community Charges for Community Based ServicesBased Services

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Introduction Introduction

Purpose is to establish a uniform fee collection policy that:

Is equitableProvides for collectionsMaximizes contributions to local revenue

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Support the following principlesSupport the following principles

1. Persons are charged for services based on ability to pay.

2. Procedures are fair, equitable and consistently implemented.

3. Paying for services reinforces role as a customer.

4. Earned revenues are optimized.5. The department is the payer of last resort.

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Persons eligible for services must not be denied because of inability to pay.

Persons in crisis must not be denied services if financial is not assessed, past due account or has service involuntarily reduced or terminated due to non-payment.

Person cannot be denied services if there is a pending resolution of an issue relating solely to payment.

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Hill Country MHMR is Hill Country MHMR is responsible to identify and responsible to identify and access available resourcesaccess available resources Third Party coverageState and/or local governmental agency

fundsQualified Medicare Beneficiary ProgramIndigent Pharmaceutical programsTrust funds that provide health care

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CHILDREN WHO MAY BE CHILDREN WHO MAY BE ELIGIBLE FOR CHIP OR ELIGIBLE FOR CHIP OR MEDICAIDMEDICAIDFamily must apply for these services. If they fail to comply, they will be charged

full standard fees after 30 days. This does include medications.

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ADULT PERSONS WHO MAY ADULT PERSONS WHO MAY BE ELIGIBLE FOR MEDICAIDBE ELIGIBLE FOR MEDICAIDMust apply for SSIOr provide proof of denialConsumer Benefits tool must be completed

when services begin and annually at a minimum.

Recovery coach completes when consumer has no benefits.

Support staff complete if they do have benefits

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Medicare Part DMedicare Part D Consumers who are full subsidy eligible must choose and

enroll in a Medicare D Plan. Hill Country MHMR support staff educate on the

benefits of enrollment. Hill Country MHMR support staff educate consumers

who are not eligible for full subsidy. Hill Country does not pay for drug co-pays and

deductibles. Staff assist with Patient Assistance when available.

If consumer is unable to enroll due to mental illness, lack of adequate notification or other circumstances, Hill Country MHMR will continue to provide medications.

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Financial AssessmentFinancial Assessment

Completed and documented for each person within first 30 days of services

Updated annuallyNote: Hill Country procedure is that staff

are required to complete the financial assessment at Intake. However the rule states 30 days.

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Required Financial Required Financial DocumentationDocumentationProof of annual or monthly

income/earningsProof of extraordinary expensesNumber of family members and agesNumber of family members receiving

servicesThird party coverage

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Proof of income that can be Proof of income that can be accepted (all must be current)accepted (all must be current) Pay stubs Income tax form Medicaid card Medicare card SSI/SSDI/Social security

benefits award letter Copy of bank statement

if Social Security is direct deposited (cannot be used for any other income documentation)

Statement from employer

Statement from consumer

Statement from someone who supports consumer

TANF award letter/food stamps award letter

Medicare Part D card

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Extraordinary expensesExtraordinary expenses

Medical expenses – doctor, medication or hospital bills that are being paid

Child care expenses – day care or babysitter

Major casualty loss – house burns, flood

These must be documented by a current paid receipt

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Failure to Provide Financial Failure to Provide Financial DocumentationDocumentation

Will result in being charged full standard rate for services unless:

Failure is related to person’s mental illness as determined by interdisciplinary team.

Team determines enforcement could result in reduction of function.

Waiver of Fees form is completed AND MUST BE SIGNED by physician/LPHA.

Determination is reassessed at least every 90 days.

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Maximum Monthly Fee (MMF)Maximum Monthly Fee (MMF)

Calculation is based on number in familyAnnual gross income reduced by verified

extraordinary expenses paid or projected

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INABILITY TO PAYINABILITY TO PAY

A MAXIMUM MONTHLY FEE OF ZERO ESTABLISHES WHO IS DETERMINED AS HAVING AN INABILITY TO PAY BASED ON FINANCIAL ASSESSMENT.

NO OTHER MINIMUM FEES MAY BE ASSESSED

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ABILITY TO PAYABILITY TO PAY

A PERSON WHO HAS THIRD PARTY COVERAGE HAS THE ABILITY TO PAY

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WHAT IS GIVEN TO WHAT IS GIVEN TO CONSUMER TO INFORM AND CONSUMER TO INFORM AND NOTIFYNOTIFY1. BROCHURE2. COPY OF FINANCIAL FORM WITH

SIGNATURE PAGE3. COPY OF FEE SCHEDULE WITH

MMF HIGHLIGHTED4. COPY OF SIGNED CONSENT FOR

SERVICES FORM

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WHAT IF A CONSUMER WHAT IF A CONSUMER DOES NOT WANT TO DOES NOT WANT TO DISCLOSE THEIR INCOMEDISCLOSE THEIR INCOME

1. THEY SIGN THE PAGE FOUR OF THE FINANCIAL

2. INDICATE ON THE FINANCIAL PORTION REFUSED TO GIVE INCOME

3. HAND THEM THE COST FOR SERVICES AND EXPLAIN THEY WILL NOW BE PAYING 100% OF CHARGES

4. GIVE THEM A COPY OF THE SIGNED FINANCIAL, MMF SCALE, AND BROCHURE

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HOW DO WE MAKE HOW DO WE MAKE REASONABLE EFFORTS TO REASONABLE EFFORTS TO COLLECTCOLLECT

Mail statementsRequest payments from consumers in the

clinic visitDocument efforts – refer to clinic

directors/business managers/recovery coaches

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FINANCIAL HARDSHIPSFINANCIAL HARDSHIPS

MUST BE DOCUMENTED

HIGH UTILITY BILL CAR REPAIRS EDUCATION COSTS ANYTHING THAT MIGHT CAUSE A

HARDSHIP – what might those be?

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SUMMARYSUMMARY

IN ORDER TO COMPLETE A FINANCIAL ONENEEDS TO HAVE THE FOLLOWING:1. NUMBER OF FAMILY MEMBERS2. AGE RANGES OF FAMILY MEMBERS

3. EXTRAORDINARY EXPENSES

4. THIRD PARTY COVERAGE5. MARITAL STATUS OF FAMILY MEMBERS6. GROSS INCOME

FINANCIAL/DEMO MUST BE COMPLETED FIRST 30 DAYS OF SERVICES AND ANNUALLY

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FAILURE TO SUBMIT DOCUMENTATION WILL RESULT IN 100% PAY FOR SERVICES.

THE CONSUMER IS GIVEN THE BROCHURE/COPY OF FINANCIAL/PAY FEE SCHEDULE.

FINANCIAL HARDSHIPS ARE APPROVED BY CENTER DIRECTOR.

WE COLLECT WITH CLIENT STATEMENTS.

Notes on family size.

A Person who is aged 18 or older is considered an adult regardless if they live with parents.

Family members include children under age of 18 who are adopted or biological relation to person in service.

Family members include legally married spouses regardless of age.

We do not count children’s income.